Provider Demographics
NPI:1144870346
Name:CUTUGNO, KELLY LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:CUTUGNO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WAINWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3222
Mailing Address - Country:US
Mailing Address - Phone:347-633-7711
Mailing Address - Fax:
Practice Address - Street 1:1860 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2128
Practice Address - Country:US
Practice Address - Phone:718-442-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist